SWELL
Oral Mucositis
Assessment Tool
SWELL translates your experience into clear, meaningful insights for you and your care team
SWELL is a self-assessment tool developed by Enlivity to help bridge the gap between what patients feel and how symptoms are clinically assessed—ensuring that your experience is recognized, not just what’s visible.
Mucositis is typically measured using clinical grading scales (like WHO or CTCAE) that focus on redness and ulcers. But these tools don’t always capture the full picture—like the burning, stinging, and rawness that can make eating, sleeping, and talking incredibly difficult.
When these symptoms aren’t fully recognized, it can delay the relief and care you need.
SWELL Oral Mucositis Scale
Scroll through the scale below to understand the progression and impact of Oral Mucositis at each level, and use the SWELL Oral Mucositis Check-In form to help guide conversations with your care team.
Level 1
Pain rating: 1 -2 out of 10
““It feels like something is off, like I’m coming down with a cold or developing allergies.”
Little to no symptoms
Dry mouth with no ulceration
Mild redness & tenderness
Scratchy throat
Minor changes to diet
Mild burning after spicy, salty, acidic foods
Recurring discomfort when swallowing
Can speak with little to no discomfort
Mouth feels tight or tender
Things to consider:
-
Symptoms are mild and shouldn’t impact your treatment plan.
Pain management is not needed
There is no impact on hydration or nutrition
-
Little to no impact on patient’s day-to-day life
May experience some discomfort or sensitivity while eating
-
To avoid pain and sensitivity, you might try omitting spicy or acidic foods from your diet, including:
Hot sauces
Chillis or peppers
Pickles
Hot chips or spicy snacks
Level 2
Pain rating: 3 - 4 out of 10
“My discomfort and pain is more persistent, like having a sore throat from a common cold.”
Symptoms are mild but consistent
Small, localized ulcers
Widespread redness & tenderness
Throat feels raw and stings when swallowing
Lips dry or chapped
Noticeable reluctance to eat certain foods
Uncomfortable pain when eating spicy, salty, acidic or textured foods
Swallowing is painful
Long conversations are painful
Talking starts to feel uncomfortable as mouth feels dry or agitated
Things to consider:
-
You should be able to continue with treatment with little to no impact.
NSAIDs like Advil or Tylenol may help manage pain while eating
Work with an oncology dietitian to develop a customized meal plan that helps you stay hydrated and nourished
-
Although the pain is distracting, daily life can likely continue with some adjustments.
OTC painkillers and NSAIDS may help you manage any pain
You may feel reluctant to attend social gatherings or meals
May begin to feel anxious or depressed as symptoms affect your lifestyle and diet
-
To avoid pain and discomfort, try avoiding foods such as:
Lemonade and sodas
Citrus fruits
Tomatoes
Onions
Crackers
Dry toast
Potato chips or other textured snacks
Level 3
Pain rating: 5 - 6 out of 10
“The pain becomes constant and overwhelming, like a severe case of strep throat.”
Symptoms are widespread and concerning
Patches of small ulcers develop more frequently and may begin joining together
The pain is constant - it doesn’t go away
Tonge, mouth or throat experience significant swelling, redness or blistering
Surfaces inside the mouth and throat are easily damaged
Throat stings, even when not eating
Lips grow cracked & sensitive
Only cold, soft or bland foods can be eaten without causing significant pain.
Solid or textured foods are painful and difficult to chew or swallow
Consuming acidic, spicy or hot foods or beverages causes excruciating pain
Any talking becomes difficult or painful
Mouth feels swollen and is difficult to move
Even slight tongue or lip movement is uncomfortable
Things to consider:
-
Your healthcare provider may step in to help manage symptoms.
NSAIDs and other OTC painkillers may no longer provide adequate pain relief
Supplements may be required to stay nourished and maintain a healthy weight
Unplanned doctor visits may be required to manage and monitor your symptoms
-
Managing symptoms becomes a full-time effort. You may find yourself:
Distracted from work, chores due to pain
Unable to relax
Struggling to fall and stay asleep
Feeling alienated
Anxious about meal time and unable to enjoy your favorite foods
Caretakers and family members are also emotionally affected as they begin to notice your pain. They work harder to adapt to your dietary changes and assume additional household chores.
-
Even soft, bland foods may cause discomfort, which may require you to make significant changes to your diet. Consider preparing foods like:
Mashed potatoes
Pureed fruit and vegetables
Luke warm soups and broth
Protien shakes
Smoothies
Puddings and jello
Level 4
Pain rating: 7 - 8 out of 10
“The pain has become constant and debilitating. It feels like I have 2nd degree burns in my mouth and throat.”
⚠ Symptoms are becoming life-threatening
Large deep ulcers
Severe swelling & blistering
Bleeding after eating or brushing
Chronic severe throat pain
Lips ulcerated or extremely sensitive
You can only eat very soft or liquid foods and may avoid eating or drinking entirely
Swelling and pain makes consuming anything excruciating, even water
Unable to properly open mouth, chew or swallow due to swelling
Conversations become very short. You may avoid speaking entirely
Swelling makes moving your mouth and throat almost impossible
Ulcers and blistering make talking painful and cumbersome
Things to consider:
-
Significant clinical support may be necessary. Your cancer treatment might need to be adjusted or temporarily paused in order to avoid your mucositis symptoms from worsening.
Intervention by you cancer care team will be crucial to help ensure you remain nourished, hydrated and healthy enough to continue with treatment
Prescription opioids or analgesics may provide pain relief, but can further weaken the immune system
-
Symptoms may make going about everyday tasks incredibly difficult, including:
Falling and staying asleep
Completing basic daily tasks at home
Going to work or focusing on work-related tasks
Communicating with loved ones and healthcare providers
Being motivated to spend quality time recharging or spending time with loved ones
Relationships may suffer from significant strain as caretakers and family or friends struggle to assume significant shares of household duties.
Symptoms of stress, anxiety and depression may worsen as the condition becomes overwhelming and you grow exhausted from lack of adequate pain relief.
-
The pain and discomfort from your symptoms may restrict your diet to cold, liquid options, such as:
Non-acidic smoothies
Hydrating energy drinks
Watery nutritional shakes
Clear broth
A dietitian or a member of your cancer care team can provide tailored meal plans to help address nutritional deficiencies.
Level 5
Pain rating: 9 - 10 +
“Pain at this level is hard to imagine. My mouth and throat are eroded and it feels like I have 3rd degree burns.”
⚠ Emergency medical care needed immediately
Eroded & decayed tissue with constant bleeding
Mouth and throat pain unbearable
Tissue feels leathery and dry
Rancid breath
Severe widespread swelling restricts you from moving your mouth and tongue
Deep cracks and sores on the lips
Eating & Drinking practically impossible. The risk of malnutrition and dehydration is significant.
Feeding tube or IV hydration required
Opening your mouth, chewing and swallowing is excruciating and very difficult
Conversation is almost non-existent. You may be physically unable to talk.
Swelling makes opening the mouth to speak physically impossible
Even small movements of mouth, lips and throat cause overwhelming pain
Things to consider:
-
Your cancer treatment may be stopped entirely as hydration and nutrition become the top priority. Emergency medical attention should be sought immediately
Extended hospital stays may be required
Invasive medical options replace eating and drinking entirely
Only strong pain relievers such as Morphine will provide any relief
Risk of secondary infections becomes high
-
Your symptoms interfere with every aspect of your life.
You may be admitted to hospital for close monitoring by healthcare professionals
Pain turns basic self-care activities into exhausting challenges
You feel an overwhelming sense of hopelessness and loss that makes you stressed, anxious or depressed
Caretakers may struggle to cope as they assume full responsibility for household tasks and juggle frequent hospital visits
Worry and frustration may weigh heavily on family and friends
-
Diet and hydration are managed by healthcare professionals
The SWELL Oral Mucositis Scale is intended for educational purposes to support awareness and communication about oral mucositis. It is not a diagnostic or clinical assessment tool.
This information is not intended as medical advice. Always consult your healthcare provider regarding any symptoms or changes in your condition.
Symptoms and experiences may vary between individuals.
SWELL™ is a trademark of Enlivity Corporation. Trademark and patent pending.